A DAY IN THE LIFE OF A PATIENT
I had an unpleasant experience within a local hospital in central New Jersey over the past few days. I witnessed many health care inconsistencies and realized why patients become so upset after a hospital stay. They include the following:
Actual Experience: Environmental Service Worker enters the patient room without introducing oneself, acknowledging the patient or why one has entered the private space.
The Ideal Scenario: The Environmental Service Worker knocks on the door and properly introduces oneself before entering the patient's space. The worker should first ask, "Would this be a good time for me to clean your room?"
Actual Experience: Nurse enters the patient room and begins communication with the patient by saying, "Good Morning." The nurse then asked the patient about all medications without first consulting the medical record. The patient responded by saying, "I've been taking the same medications that you've been asking me to take for the past three days." The patient then asked the health care worker to consult her computer for additional information.
The Ideal Scenario: Before the nurse entered the patient room, the nurse should have already gathered all relevant patient information. By gathering all information prior to entering the patient's room, this decreases patient anxiety and stress from having to recall all medications.
Actual Experience: The nurse stated that she would be dispensing new medication to the patient, but never explained why. The patient then asked why one needs the additional pills and her response was extremely vague and did not provide any clarity, only that the patient had to take the medication due to "doctor's orders."
The Ideal Scenario: The nurse should have stated all reasons for changing medication to both the patient and the patient's family including benefits for the new medication.
Actual Experience: Nurse asked patient about location of stent without consulting a health care resource. The patient responded by explaining that the hospital performed the surgery only a few years prior. The nurse replied with, "We don't have that information," and the patient was left questioning if his medical records were complete.
The Ideal Scenario: The nurse should review the patient's medical history diligently prior to performing patient care.
Actual Experience: Nurse re-entered the patient's room asking for any additional information regarding the stent that was recently implemented. The nurse explained that the patient was given a card when the surgery was performed and asked to see it for verification purposes. The patient gave the nurse the card and the nurse walked away. This scene played out on three more occasions because the nurse needed additional information.
The Ideal Scenario: The nurse should have recorded all patient information when the patient entered the health care facility rather than asking the patient multiple times for the same patient history.
Actual Experience: Patient was scheduled to have an MRI performed promptly at 9:00 a.m. and was told directions the night prior. At 10:00 a.m., family members contacted a nurse to ask why the procedure was already an hour late. The nurse explained that the staff was overbooked and that they were working to expedite the exams. She explained to the family members that they should contact the nurse again after thirty minutes to verify the new time for the MRI procedure. Family member contacted the nurse about sixty minutes after receiving this information and explained that the patient was becoming anxious and irritable because the patient was forced to not ingest any material as he was labeled "NPO" or "nothing by mouth". The family member recommended that the MRI be pushed back until afternoon hours. The nurse explained that it was a great idea and asked for the family member to relay the news back to the patient by saying, "Why don't you tell the patient the update?" The patient did receive the MRI exam at 4:30 p.m.
The Ideal Scenario: The nurse should have exhibited transparent and clear communication throughout the patient interaction. If the procedure was running late, the nurse should have informed the patient and all family members so they can prepare for the next steps. The nurse should have been pro- active regarding patient care rather than have the family members initiate communication and the plan of action.
Actual Experience: The dietician entered the patient's room during the late morning hours and asked the patient what he preferred for lunch. The patient stated, "I can't eat because I am due for an MRI. Do you communicate to the nursing staff?" The dietician stated that there were no records explaining that the patient could not ingest food.
The Ideal Scenario: All hospital staff needs to collaborate and communicate with one another to provide superior patient care. Documentation on the patient medical record is significant for all health care workers to receive the same patient care plan.
This short list encompasses various hospital inconsistencies including lack of communication and quality of care issues that occurred within a 24 hour time frame. These unfortunate activities build the case for a standardized and engaged work force who will work as a team with the patient's family and/or friends.
I witnessed these events because the patient is my father and I work as a health care executive. Communication, engagement and consistency are the foundation for providing high quality and safe health care.